Medicare Reimbursement for CPT 21206

CPT 21206 is a surgical procedure code reported to Medicare for payment under the Physician Fee Schedule (PFS). This page shows the estimated PFS allowed amount for this code nationally and, where available, by locality, broken out by non-facility and facility settings. Amounts reflect standard Medicare-assigned rates before adjustments for modifiers or site-specific factors.

Medicare allowed amount (2026)

Locality	Non-facility	Facility
National (unadjusted)	$873.43	$873.43
ALASKA* (AK)	$1120.84	$1120.84
ALABAMA (AL)	$809.55	$809.55
ARKANSAS (AR)	$801.64	$801.64
ARIZONA (AZ)	$855.45	$855.45
SAN FRANCISCO-OAKLAND-BERKELEY (SAN FRANCISCO/SAN MATEO/ALAMEDA/CONTRA COSTA CNTY) (CA)	$1013.71	$1013.71
SAN JOSE-SUNNYVALE-SANTA CLARA (SANTA CLARA CNTY) (CA)	$1029.51	$1029.51
OXNARD-THOUSAND OAKS-VENTURA (CA)	$921.35	$921.35
LOS ANGELES-LONG BEACH-ANAHEIM (LOS ANGELES/ORANGE CNTY) (CA)	$930.67	$930.67
NAPA (CA)	$974.11	$974.11
SAN FRANCISCO-OAKLAND-BERKELEY (MARIN CNTY) (CA)	$1015.71	$1015.71
VALLEJO (CA)	$971.23	$971.23
BAKERSFIELD (CA)	$889.56	$889.56
CHICO (CA)	$884.26	$884.26
FRESNO (CA)	$884.26	$884.26
HANFORD-CORCORAN (CA)	$884.26	$884.26
MADERA (CA)	$884.26	$884.26
MERCED (CA)	$884.26	$884.26
MODESTO (CA)	$884.26	$884.26
REDDING (CA)	$884.26	$884.26
RIVERSIDE-SAN BERNARDINO-ONTARIO (CA)	$903.40	$903.40
SACRAMENTO-ROSEVILLE-FOLSOM (CA)	$914.47	$914.47
SALINAS (CA)	$910.70	$910.70
SAN JOSE-SUNNYVALE-SANTA CLARA (SAN BENITO CNTY) (CA)	$1037.68	$1037.68
SANTA CRUZ-WATSONVILLE (CA)	$922.81	$922.81
SANTA ROSA-PETALUMA (CA)	$931.37	$931.37
STOCKTON (CA)	$884.26	$884.26
VISALIA (CA)	$884.26	$884.26
YUBA CITY (CA)	$884.26	$884.26
EL CENTRO (CA)	$884.55	$884.55
SAN DIEGO-CHULA VISTA-CARLSBAD (CA)	$921.90	$921.90
SAN LUIS OBISPO-PASO ROBLES (CA)	$897.45	$897.45
SANTA MARIA-SANTA BARBARA (CA)	$911.33	$911.33
REST OF CALIFORNIA (CA)	$884.26	$884.26
COLORADO (CO)	$886.30	$886.30
CONNECTICUT (CT)	$919.57	$919.57
DC + MD/VA SUBURBS (DC)	$962.13	$962.13
DELAWARE (DE)	$866.35	$866.35
FORT LAUDERDALE (FL)	$924.92	$924.92
MIAMI (FL)	$975.90	$975.90
REST OF FLORIDA (FL)	$889.50	$889.50
ATLANTA (GA)	$891.68	$891.68
REST OF GEORGIA (GA)	$851.57	$851.57
HAWAII, GUAM (HI)	$890.74	$890.74
IOWA (IA)	$811.89	$811.89
IDAHO (ID)	$817.90	$817.90
EAST ST. LOUIS (IL)	$908.49	$908.49
SUBURBAN CHICAGO (IL)	$930.66	$930.66
CHICAGO (IL)	$954.65	$954.65
REST OF ILLINOIS (IL)	$879.82	$879.82
INDIANA (IN)	$820.81	$820.81
KANSAS (KS)	$814.81	$814.81
KENTUCKY (KY)	$834.36	$834.36
NEW ORLEANS (LA)	$863.32	$863.32
REST OF LOUISIANA (LA)	$835.66	$835.66
METROPOLITAN BOSTON (MA)	$947.33	$947.33
REST OF MASSACHUSETTS (MA)	$885.89	$885.89
BALTIMORE/SURR. CNTYS (MD)	$917.90	$917.90
REST OF MARYLAND (MD)	$877.37	$877.37
SOUTHERN MAINE (ME)	$848.98	$848.98
REST OF MAINE (ME)	$826.66	$826.66
DETROIT (MI)	$903.02	$903.02
REST OF MICHIGAN (MI)	$854.31	$854.31
MINNESOTA (MN)	$840.95	$840.95
METROPOLITAN ST. LOUIS (MO)	$858.82	$858.82
METROPOLITAN KANSAS CITY (MO)	$853.36	$853.36
REST OF MISSOURI (MO)	$829.55	$829.55
MISSISSIPPI (MS)	$815.42	$815.42
MONTANA** (MT)	$873.32	$873.32
NORTH CAROLINA (NC)	$831.65	$831.65
NORTH DAKOTA** (ND)	$838.51	$838.51
NEBRASKA (NE)	$813.23	$813.23
NEW HAMPSHIRE (NH)	$878.67	$878.67
NORTHERN NJ (NJ)	$958.53	$958.53
REST OF NEW JERSEY (NJ)	$927.68	$927.68
NEW MEXICO (NM)	$859.77	$859.77
NEVADA** (NV)	$863.92	$863.92
MANHATTAN (NY)	$990.10	$990.10
NYC SUBURBS/LONG ISLAND (NY)	$1014.32	$1014.32
POUGHKPSIE/N NYC SUBURBS (NY)	$937.79	$937.79
QUEENS (NY)	$987.77	$987.77
REST OF NEW YORK (NY)	$840.63	$840.63
OHIO (OH)	$847.20	$847.20
OKLAHOMA (OK)	$827.48	$827.48
PORTLAND (OR)	$900.58	$900.58
REST OF OREGON (OR)	$854.75	$854.75
METROPOLITAN PHILADELPHIA (PA)	$906.50	$906.50
REST OF PENNSYLVANIA (PA)	$845.03	$845.03
PUERTO RICO (PR)	$875.93	$875.93
RHODE ISLAND (RI)	$886.86	$886.86
SOUTH CAROLINA (SC)	$841.29	$841.29
SOUTH DAKOTA** (SD)	$834.40	$834.40
TENNESSEE (TN)	$818.28	$818.28
BRAZORIA (TX)	$861.80	$861.80
DALLAS (TX)	$868.43	$868.43
GALVESTON (TX)	$865.24	$865.24
HOUSTON (TX)	$897.45	$897.45
BEAUMONT (TX)	$841.63	$841.63
FORT WORTH (TX)	$866.12	$866.12
AUSTIN (TX)	$885.55	$885.55
REST OF TEXAS (TX)	$852.08	$852.08
UTAH (UT)	$849.02	$849.02
VIRGINIA (VA)	$850.93	$850.93
VIRGIN ISLANDS (VI)	$875.93	$875.93
VERMONT (VT)	$841.32	$841.32
SEATTLE (KING CNTY) (WA)	$957.74	$957.74
REST OF WASHINGTON (WA)	$882.25	$882.25
WISCONSIN (WI)	$819.86	$819.86
WEST VIRGINIA (WV)	$858.56	$858.56
WYOMING** (WY)	$858.15	$858.15

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Maximum units per day (MUE)

Medicare’s Medically Unlikely Edit caps this code at 1 unit per patient per day — Date of Service Edit: Clinical. Units above the MUE are denied; some MUEs can be exceeded only with appropriate documentation and modifiers where policy allows.

How the amount is calculated

Medicare's Physician Fee Schedule amount is built from three Relative Value Units (RVUs) — physician work, practice expense, and malpractice — assigned to each code. Each RVU component is adjusted by Geographic Practice Cost Indices (GPCIs) specific to the locality where the service is furnished, then the adjusted RVUs are summed and multiplied by the annual national conversion factor to produce a dollar amount. Non-facility and facility settings can have different practice-expense RVUs because the resources required (e.g., staff, supplies, equipment) differ when a service is performed in a physician office versus a hospital or ambulatory surgical center. For this code, the non-facility and facility PE RVUs are the same, so the national allowed amount is identical across both settings; locality-level amounts may still differ due to GPCI adjustments.

RVUs — work 15.2, practice expense 9.19 (non-facility) / 9.19 (facility), malpractice 1.76 — × the locality GPCIs × the 2026 conversion factor of $33.40.

Good to know

This is an estimate only — actual Medicare payment can vary.
Medicare typically pays 80% of the allowed amount after the annual Part B deductible is met; the patient or secondary insurer is responsible for the remainder.
Modifiers, multiple-procedure reductions, bilateral billing, and other claim-specific factors can change the final paid amount.
Annual budget-neutrality adjustments, sequestration, and legislative changes to the conversion factor can alter rates year to year.
Always verify the current allowed amount and any locality-specific adjustments with your Medicare Administrative Contractor (MAC) before billing or appealing a denial.

Frequently asked

Why does the allowed amount differ between facility and non-facility settings for other codes but not this one?

The difference stems from the practice-expense RVU component, which accounts for overhead costs like staff and equipment. When the non-facility and facility PE RVUs are equal, as they are for this code, the national allowed amount is the same in both settings.

Why might the amount I see on a remittance advice differ from the national rate shown here?

Remittance amounts reflect locality-specific GPCI adjustments, any applicable modifiers, multiple-procedure payment reductions, sequestration, and the specific MAC's processing rules — none of which are reflected in a single national figure.

How is the conversion factor determined each year?

CMS publishes an annual conversion factor based on statutory formulas, budget-neutrality adjustments, and any legislative actions affecting the Physician Fee Schedule; it is applied uniformly to RVU totals nationwide before locality adjustments.

Can I use this estimate to predict exact patient responsibility?

No. Patient responsibility depends on deductible status, secondary coverage, coinsurance rates, and any applicable modifiers, so this figure should be treated as a general reference rather than a final billing amount.

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Estimated Medicare Physician Fee Schedule amount. Medicare generally pays 80% after the deductible; actual amounts vary by locality, modifiers, sequestration, and annual updates. Verify with your MAC.